颈内动脉支架置入术后支架内再狭窄相关危险因素分析

发布时间：2018-02-23 05:44

本文关键词： 颈内动脉支架内再狭窄炎症因子 TBIL　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:采用回顾性病例对照研究,探讨患者生化指标与颈内动脉支架内再狭窄发生的相关性,寻找支架内再狭窄发生的危险因素,探索支架内再狭窄的发生的主要影响因素,并判断这些因素对ISR的预测价值,为临床诊疗提供依据。方法:回顾性分析自2013年1月至2016年1月于大同市三医院经DSA确诊颈内中重度狭窄并行CAS的患者83例,定期经CDU、CTA或DSA随访3、6、9个月,1-3年。共置入83枚支架,患者年龄35~80岁(58.95±9.09),其中男性65例,女性18例。根据随访结果将随访对象分为再狭窄组12例,无再狭窄组71例。临床观察指标包括:患者临床资料、临检、生化等共22项因素。通过单因素及多因素Logistic回归分析这些因素与ISR的相关性,最后通过ROC曲线分析相关因素对ISR的预测价值。结果:83例患者中,再狭窄患者12例,再狭窄率14.5%。单因素分析显示:(1)再狭窄组与非再狭窄组在年龄、性别、高血压病、高脂血症、卒中史、冠心病、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、载脂蛋白A、术后FIB、FIB差值、术后白细胞、白细胞差值、NEUT差值比较,差异无统计学意义(P0.05);(2)与无再狭窄组比较,再狭窄组患者糖尿病比例明显偏高(66.7%vs19.7%,P=0.002);TBIL水平明显偏高[(9.27±1.56)vs(11.00±4.10),P=0.030];术后FIB明显升高[(5.13±1.46)vs(3.75±0.78),P=0.008];FIB差值[(2.08±1.50)vs(0.93±0.76),P=0.024];术后白细胞明显升高[(9.52±1.48)vs(8.23±2.44),P=0.020];白细胞差值[(2.28±1.48)vs(0.95±2.18),P=0.047];NEUT差值[(10.79±10.06)vs(5.40±8.00),P=0.041]。以是否发生再狭窄为因变量,以糖尿病、TBIL、术后FIB、术后白细胞、白细胞差值、NEUT差值为自变量,行多因素logistic回归分析,结果显示,糖尿病、术后FIB、NEUT差值被纳入回归方程,其中TBIL[OR(95%CI):0.379(0.149-0.964);P=0.042],是ISR的保护因素;糖尿病[OR(95%CI):9.644(1.177-79.051);P=0.035]、术后FIB[OR(95%CI):5.166(1.315-20.303);P=0.019]、NEUT差值[OR(95%CI):1.225(1.030-1.457);P=0.022],是ISR的独立危险因素。(3)最后通过ROC曲线分析:术后FIB、NEUT%差值及联合预测因子ROC曲线面积分别为0.795(95%CI:0.643-0.946;P=0.001)、0.656(95%CI:0.491-0.820;P=0.086)、0.883(95%CI:0.794-0.971;P0.001)。术后FIB及联合预测因子均能较好的预测ISR的发生,其中以联合预测因子诊断价值更高。结论:颈内动脉支架内再狭窄的发生率为14.5%。多因素Logistic回归分析结果显示:糖尿病史、TBIL水平、术后FIB、NEUT差值与ISR相关。其中TBIL水平是ISR的保护因素;糖尿病、术后FIB、中性粒细胞差值是ISR的独立危险因素。术后FIB及联合预测因子均能较好的预测ISR的发生,其中以联合预测因子预测价值更高。
[Abstract]:Objective: to investigate the correlation between biochemical parameters and restenosis in internal carotid artery stents, to find out the risk factors of restenosis in internal carotid artery, and to explore the main influencing factors of restenosis in stent by retrospective case-control study. To evaluate the predictive value of these factors to ISR and to provide the basis for clinical diagnosis and treatment. Methods: from January 2013 to January 2016, 83 patients with moderate or severe intracervical stenosis and CAS were retrospectively analyzed in three hospitals of Datong city. The patients were followed up by DSA or DSA for 3 ~ 6 years, 9 months and 1 ~ 3 years. 83 stents were implanted. The age of the patients was 58.95 卤9.09, including 65 males and 18 females. According to the follow-up results, 12 patients were divided into restenosis group (n = 12), restenosis group (n = 12), male (n = 65) and female (n = 18). There were 71 cases without restenosis. The clinical indexes included 22 factors, such as clinical data, clinical examination, biochemistry and so on. The correlation between these factors and ISR was analyzed by univariate and multivariate Logistic regression analysis. Finally, the predictive value of related factors to ISR was analyzed by ROC curve. Results among 83 patients with restenosis, 12 were restenosis patients, and the restenosis rate was 14.5.The univariate analysis showed that the restenosis group and non-restenosis group had age, sex, hypertension, hyperlipidemia. Stroke history, coronary heart disease, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, apolipoprotein A, postoperative FIBN FIB difference, postoperative white blood cell, leukocyte difference and neut difference were compared. There was no significant difference between the two groups (P 0.05) and the restenosis group. In the restenosis group, the percentage of diabetes mellitus patients was significantly higher than that in the restenosis group [66.7vs19.7p0. 024]; the level of TBIL was significantly higher [9.27 卤1.56vs11.00 卤4.10vs0.030]; the postoperative FIB was obviously increased [5.13 卤1.46vs3.75 卤0.78P0.008]; the difference of FIB [2.08 卤1.50v / s 0.93 卤0.76vs0.024] was significantly higher after operation [9.52 卤1.48vs/ 8.23 卤2.44vs/ 0.020]; the difference of leukocyte was 2.28 卤1.48vs0.95 卤1.18vs0.047] [10.79 卤1.06v0.040] (10.79 卤1.06vs0.040), and the incidence of restenosis was dependent on the incidence of restenosis [10.79 卤1.48vs0.40 卤0.041], and the correlation between the two groups was as follows: (1) the ratio of TBIL in the restenosis group was significantly higher than that in the control group [9.27 卤1.56 vs 11.00 卤4.10 卤4.10 vs 0.030], and the difference between the white blood cell count [2.28 卤1.48 vs / 0. 047] was 0.95 卤2.18vs0.047 [10.79 卤1.50v / 0.040]. The multivariate logistic regression analysis showed that the logistic regression analysis showed that the difference value of logistic was included in the regression equation, in which TBIL [Ori 95CIV 0.379U 0.149-0.964P0.042] was the protective factor of ISR. FIB [OR95CII: 5.1661.315-20.303P0.019] next difference [OR95 CIV: 1.2251.030-1.457P0.022], the final ROC curve was analyzed by ROC curve analysis: the difference between FIBNEN% after operation and the area of ROC curve of the combined predictor was 0.79595CI0.643-0.946 P0.001 0. 06569595 CIV 0.491-0.820P0. 086 0. 086% 0. 88395CI790.970.1P1P0. The combined factors of FIB and FIB could predict the occurrence of ISR. Conclusion: the incidence of restenosis in internal carotid artery stent was 14.5%. Multivariate Logistic regression analysis showed that TBIL level in diabetic history was higher than that in control group. The TBIL level was the protective factor of ISR, the difference of neutrophil and neutrophil was the independent risk factor of ISR in diabetes mellitus, the postoperative FIB and combined predictive factors could predict the occurrence of ISR, and the TBIL level was the protective factor of ISR, and the difference of neutrophil was the independent risk factor of ISR. Among them, the value of joint predictor is higher.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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